Provider Demographics
NPI:1962517524
Name:MUNRO, STACEY ANN (ND)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ANN
Last Name:MUNRO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 BROAD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3030
Mailing Address - Country:US
Mailing Address - Phone:860-688-2275
Mailing Address - Fax:
Practice Address - Street 1:340 BROAD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3030
Practice Address - Country:US
Practice Address - Phone:860-688-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000362175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath